[Viva] Fwd: FW: CATIE News - Researchers recommend screening HIV-positive patients for domestic violence

Wed Feb 16 12:36:53 PST 2011

---------- Forwarded message ----------
From: Ross Harvey <rossh at bcpwa.org>
Date: Tue, Feb 15, 2011 at 2:28 PM
Subject: FW: CATIE News - Researchers recommend screening HIV-positive
patients for domestic violence
To: BCPWA Program Coordination Team <BCPWAProgramCoordinationTeam at bcpwa.org>,
BCPWA Health Promotion <hp at bcpwa.org>, BCPWA Community Representation and
Engagement <BCPWACollectiveAdvocacy at bcpwa.org>

FYI

Ross Harvey

Executive Director

BC Persons With AIDS Society

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*From:* mailing at mercury.catie.ca [mailto:mailing at mercury.catie.ca]
*Sent:* February-15-11 2:16 PM
*To:* Ross Harvey
*Subject:* CATIE News - Researchers recommend screening HIV-positive
patients for domestic violence

*CATIE News - Researchers recommend screening HIV-positive patients for
domestic violence*

Both childhood and domestic abuse can cause psychological trauma, with
effects that can last for many years. Studies with women who have
experienced abuse as adults suggest that such women are more likely to
engage in behaviours that put them at heightened risk for HIV infection,
including unprotected sex with multiple partners and substance use. And
several studies with HIV-positive people have found that a history of
childhood sex abuse is common.

Researchers at a Calgary HIV clinic were made aware of a series of domestic
violence incidents among some of their patients and decided to initiate a
study of this problem. Specifically, as part of a pilot study, they screened
hundreds of their patients for abuse. Overall, the research team found that
35% of their patients had been exposed to abusive behaviour. Abuse had an
impact on patients’ willingness or ability to access HIV care. Since the
pilot study, the Calgary clinic has made screening for domestic violence a
routine part of patient health assessment and encourages other HIV clinics
to do the same.
*Study details*

All patients who sought care at Calgary’s Southern Alberta HIV clinic
between June 2009 and January 2010 were screened for several different forms
of abuse, which researchers listed as follows:

   - physical
   - sexual
   - psychological
   - emotional
   - neglect
   - isolation
   - intimidation
   - economic (controlling access to funds and how money is spent)

If participants disclosed abuse, the interview continued exploring the
nature of the abuse. All patients were asked about their feelings of
personal safety in their current relationship in order to help clinic staff
identify high-risk situations. Those patients who felt unsafe were
immediately referred to the clinic’s social worker so that necessary
intervention(s) could take place. Furthermore, referrals for patients who
requested psycho-social assistance (from social workers, psychologists) were
also made.
*Results*

A total of 853 patients were screened during the study period, with about
34% disclosing a history of abuse, distributed as follows:

   - 14% reported experiencing domestic violence
   - 10% reported experiencing abuse during childhood
   - 10% reported experiencing abuse both in childhood and adulthood

Of the participants who disclosed abuse, nearly 60% reported more than one
type of abuse. The researchers also found a strong link between experiencing
abuse as a child and later experiencing abuse as an adult.
*Demographics*

As with past studies, in the Calgary study women were significantly more
likely than men to have been abused. Other findings included the following:

   - Aborginal Canadians (including First Nations people, Métis and Inuit)
   had the highest rate of abuse (61%).
   - Patients who self-identified as Black had the lowest rate of abuse in
   childhood and adulthood. Most (97%) of the Black participants were
   immigrants from sub-Saharan Africa. Some studies in that region have found
   high rates of domestic violence against women, so the reason for the
   relatively low rate of disclosure about abuse by Black people in the present
   study is not clear. The study team noted that the 2003 Canadian Women’s
   Health Surveillance Report found that “women born outside of Canada report
   lower rates of all types of violence compared to Canadian-born women.”
   - Heterosexual women (41%) were more likely to disclose a history of
   abuse than heterosexual men (26%).
   - About 34% of gay men reported abuse, as did 44% of bisexual patients of
   either gender.
   - People who injected street drugs were more likely to experience abuse
   (nearly 50%) compared to men who had sex with men (31%).

*Pre-existing mental health issues*

In looking at all of the participants who were screened, researchers found
that many had pre-existing mental health issues, including these:

   - 25% of participants reported a history of depression
   - 15% of participants reported a history of anxiety
   - 11% had thoughts of or had attempted suicide

Participants who reported any of these issues were more likely to have
experienced abuse.
*Health-seeking behaviour*

In the present study, people who disclosed abuse were more likely to have
delayed accessing care and treatment for HIV infection than people who did
not report a history of abuse.
*Screening*

The screening for abuse was well received both by clinic staff and
participants. Although 97% of participants responded to questions about
abuse in the initial screening, the remaining participants required further
discussion with nurses and doctors before disclosing abuse. This finding
suggests that having a trusting relationship with a health care practitioner
enables full disclosure from patients. The Calgary researchers noted that
repeated interaction with the same health care staff at the clinic may
foster trust and enable an “open dialogue” between health care providers and
patients. They further added that the HIV clinic came to be perceived as a
safe space for some patients who had no other trusted relationships for
disclosing abuse in their lives.
*Immediate intervention*

Nine participants who were screened for abuse required immediate
intervention and the clinic facilitated their “transition to safe housing
shelter, removing [these] patients from immediate risk of harm.”
*Overall*

The researchers noted that the high rate of abuse within the HIV community
in this and other studies “highlights the need for domestic violence
intervention and awareness programs targeted specifically at those living
with HIV.” The Calgary research team stated that health care providers
caring for HIV-positive people “need to be aware of the high rate of abuse
among their patients and encourage screening, given the high impact of
domestic abuse on health outcomes such as consistent access to HIV care,
mental health and physical health.”

*—Sean R. Hosein*

REFERENCE:

Siemieniuk RA, Krentz HB, Gish JA, Gill MJ. Domestic violence screening:
prevalence and outcomes in a Canadian HIV population. *AIDS Patient Care and
STDs*. 2010 Dec;24(12):763-70.

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